Morken Katharina T E, Øvrebø Morten, Klippenberg Charlotte, Morvik Therese, Lied Gikling Elisabeth
Department of Clinical Psychology, University of Bergen, Bergen, Norway; Department of Addiction Medicine, Research Section, Haukeland University Hospital, Bergen.
Department of Addiction Medicine, Haukeland University Hospital, Bergen.
Res Psychother. 2022 Nov 7;25(3):649. doi: 10.4081/ripppo.2022.649.
Patients with antisocial personality disorder (ASPD) are known for being difficult to treat. Treatment for ASPD is debated and lacking evidence. Among several reasons for treatment difficulties concerning ASPD, negative countertransference in health personnel is one central topic. Mentalization based treatment (MBT) is a reasonable candidate treatment for ASPD. From an ongoing pilot-study on MBT with substance using ASPD patients, we explore therapist experiences. Four experienced MBT therapists together with the principal investigator performed a focus group together. The therapists were themselves involved in performing this study and analyses are made as an autoethnographic study, with thematic analyses as methodological approach. As this study involved a qualitative investigation of own practice, reflexivity of the processes was performed. The aim was to explore in depth: therapist experiences and therapist wellbeing in MBT-ASPD. We found four main themes on therapist experiences: i) gaining safety by getting to know them better; ii) gaining cooperation through clear boundaries and a non-judgmental stance; iii) shifting inner boundaries; and iv) timing interventions in a high-speed culture. These four themes point to different therapist experiences one can have in MBT-ASPD. Our findings resonate well with the clinical literature on ASPD, the findings imply that clinical teams should have a focus on therapist countertransference and burnout, ensure that therapists uphold boundaries and open-mindedness in treatment of ASPD and that therapists experience vitalizing feelings in this line of work.
患有反社会人格障碍（ASPD）的患者以难以治疗而闻名。针对ASPD的治疗存在争议且缺乏证据。在与ASPD治疗困难相关的几个原因中，医护人员的消极反移情是一个核心话题。基于心理化的治疗（MBT）是ASPD一种合理的候选治疗方法。从一项正在进行的针对使用物质的ASPD患者的MBT试点研究中，我们探索治疗师的经验。四位经验丰富的MBT治疗师与首席研究员一起进行了一次焦点小组讨论。治疗师们自己参与了这项研究，分析作为一项自我民族志研究进行，采用主题分析作为方法论方法。由于这项研究涉及对自身实践的定性调查，因此对过程进行了反思。目的是深入探索：MBT - ASPD中治疗师的经验和治疗师的幸福感。我们发现了关于治疗师经验的四个主要主题：i）通过更好地了解他们来获得安全感；ii）通过明确的界限和非评判性的立场获得合作；iii）改变内心的界限；iv）在高速文化中把握干预时机。这四个主题指出了治疗师在MBT - ASPD中可能拥有的不同经验。我们的研究结果与关于ASPD的临床文献高度契合，这些结果表明临床团队应关注治疗师的反移情和职业倦怠，确保治疗师在治疗ASPD时坚持界限和开放的心态，并且治疗师在这项工作中体验到充满活力的感觉。
